Vitiligo Patient Access to Care Question Title * 1. Has a doctor ever diagnosed you with vitiligo? Yes No Question Title * 2. If you answered No to Question 1, do not proceed with this survey.If you answered Yes, please continue.Have you ever been treated or offered treatment for your vitiligo with a prescription/medical therapy? Yes No Question Title * 3. Have you ever received phototherapy or excimer laser treatment for your vitiligo? Yes No Question Title * 4. How old are you? (please answer in years and months) Question Title * 5. How old were you when your vitiligo began? (please answer in years and months) Question Title * 6. When was the first time you saw a doctor for vitiligo? (please answer as a whole number year e.g. 2012) Question Title * 7. Did the first doctor you saw offer you therapy for your vitiligo? Yes No Question Title * 8. How many doctors did you see before you were offered therapy for vitiligo? Whole number answer Question Title * 9. Have you ever been prescribed protopic® (tacrolimus) for your vitiligo? Yes No Question Title * 10. If you answered yes to #9, did you experience difficulty getting this medication? Yes No Question Title * 11. If you answered yes to #10, what kind of difficulty did you have obtaining the protopic ®? Please write in problems not listed or list all the letters that apply No Insurance coverage for the medication Prior authorization failed to produce coverage of the medication Your copay was prohibitively expensive Your deductible was very high You were uncomfortable with the medication’s side effects The tube was too small to cover your skin affected areas Other (please specify) Question Title * 12. Have you ever been prescribed elidel ® (pimecrolimus) cream for your vitiligo? Yes No Question Title * 13. If you answered yes to #12, did you experience difficulty getting elidel ® (pimecrolimus)? Yes No Question Title * 14. If you answered yes to #13, what kind of difficulty did you have obtaining the elidel ® (pimecrolimus) ? Please write in problems not listed or list all the letters that apply No Insurance coverage for the medication Your deductible was too high Prior authorization failed to produce coverage of the medication Your copay was prohibitively expensive You were uncomfortable with the medication’s side effects The tube was too small to cover your skin affected areas Other (please specify) Question Title * 15. Have you ever been prescribed topical (cream, spray, lotion, foam or ointment) steroids (e.g. clobetasol, mometasone, triamcinolone or hydrocortisone) for your vitiligo? Yes No Question Title * 16. If you answered yes to #15, did you experience difficulty getting this medication? Yes No Question Title * 17. If you answered yes to #16, what kind of difficulty did you have obtaining the topical steroid? Please write in problems not listed or list all the letters that apply No Insurance coverage for the medication Prior authorization failed to produce coverage of the medication Your deductible was too high Your copay was prohibitively expensive You were uncomfortable with the medication’s side effects The tube was too small to cover your skin affected areas Other (please specify) Question Title * 18. Have you ever been told by a physician that you need phototherapy (ultraviolet light therapy, Narrowband UVB, Psoralens and UVA, PUVA)? Yes No Question Title * 19. If you answered yes for #18, what type of phototherapy were you recommended? Check all that apply. Ultraviolet light therapy Narrowband UVB Psoralens and UVA PUVA Question Title * 20. How many years did you have vitiligo at the time you first discussed phototherapy with your physician? (please answer in years and months) Question Title * 21. Did you proceed with phototherapy when it was discussed by your physician? Yes No Question Title * 22. Did you have health insurance at that time? Yes No Question Title * 23. Were you given any other therapies at the time of the phototherapy? Please list, including vitamins and creams. Question Title * 24. If you answered yes to #22, did your health insurance cover the phototherapy? (Answer Yes even if you were only partially covered) Yes No Question Title * 25. How much did you pay out of pocket for each phototherapy session? Question Title * 26. Was the payment for #24: Deductible Copay Out of pocket payment Other (Write in answer) Question Title * 27. From where do/did you travel to phototherapy? Work School Home Other (please specify) Question Title * 28. How far away from your work/school was the phototherapy center? <10 minutes commute 10-30 minutes 31-45 minutes 46-60 minutes 61-90 minutes > 90 minutes Other (please specify) Question Title * 29. How far away from your home was the phototherapy center? <10 minutes commute 10-30 minutes 31-45 minutes 46-60 minutes 61-90 minutes > 90 minutes Other (please specify) Question Title * 30. What was the cost of commutation to the phototherapy center (per session) in dollars (roundtrip)? Question Title * 31. Did the phototherapy sessions interfere with any of the following activities? Check all that apply. School Work Relationships Child care Other healthcare Recreational activities Other (please specify) Question Title * 32. How much did phototherapy interfere with your daily life? Not at all A little Somewhat Quite A bit Severely Question Title * 33. What barriers to receiving phototherapy did you find that we haven’t listed above? Question Title * 34. Where were you treated for vitiligo with phototherapy? Question Title * 35. How many treatment series for phototherapy have you had? (Each series would be distinct if at least 3 month hiatus occurred. Please answer in whole numbers.) Question Title * 36. How many sessions of phototherapy did you undergo (overall)? Please answer in whole numbers. Question Title * 37. If you stopped phototherapy before your doctor told you to do so, why did you do stop? Question Title * 38. Did you get color from the therapy? Yes No Question Title * 39. How were your results? Worsened None Good Very Good Excellent Question Title * 40. Were you satisfied with the therapy? Yes No Question Title * 41. If you answered No for #40, why weren’t you satisfied? Question Title * 42. How many years has it been since you completed phototherapy? Please answer in whole numbers. Question Title * 43. Have you ever been told by a physician that you need excimer laser therapy? Yes No Question Title * 44. Where did you live at the time you were doing excimer laser? City, State, Country, Zip code Question Title * 45. How many years did you have vitiligo at the time you first discussed excimer laser therapy with your physician? (Please answer in years and months) Question Title * 46. Did you proceed with excimer laser therapy when it was discussed by your physician? Yes No Question Title * 47. Did you have health insurance at that time? Yes No Question Title * 48. Were you given any other therapies at the time of the excimer laser therapy, please list including vitamins and creams? Write in answer Question Title * 49. If you answered Yes to #47, did your health insurance cover the excimer laser therapy? (Answer Yes even if you were only partially covered) Yes No Question Title * 50. How much did you pay out of pocket for each excimer laser therapy session? Question Title * 51. Was the payment for #50: Deductible Copay Out of pocket payment Other (please specify) Question Title * 52. From where do/did you travel to excimer laser therapy? Check all that apply. Work School Home Other (please specify) Question Title * 53. How far away from your work/school was the excimer laser therapy center? <10 minutes commute 10-30 minutes 31-45 minutes 46-60 minutes 61-90 minutes > 90 minutes Other (please specify) Question Title * 54. How far away from your home was the excimer laser therapy center? <10 minutes commute 10-30 minutes 31-45 minutes 46-60 minutes 61-90 minutes > 90 minutes Other (please specify) Question Title * 55. What was the cost of commutation to the excimer laser therapy center (per session) in dollars (roundtrip)? Question Title * 56. Did the excimer laser therapy sessions interfere with any of the following activities? Check all that apply. School Work Relationships Child Care Other healthcare Recreational activities Other (please specify) Question Title * 57. How much did excimer laser therapy interfere with your daily life? Not at all A little Somewhat Quite A bit Severely Question Title * 58. What barriers to receiving excimer laser therapy did you find that we haven’t listed above? Question Title * 59. Where were you treated for vitiligo with excimer laser therapy? Question Title * 60. How many treatment series for excimer laser therapy have you had? (Each series would be distinct if a 3 month hiatus occurred. Please answer in whole numbers.) Question Title * 61. How many sessions of excimer laser therapy did you undergo (overall)? Question Title * 62. If you stopped excimer laser therapy before your doctor told you to do so, why did you do stop? Question Title * 63. Did you get color from the therapy? Yes No Question Title * 64. How were your results? Worsened None Good Very Good Excellent Question Title * 65. Were you satisfied with the therapy? Yes No Question Title * 66. If No for #65, why weren’t you satisfied? Question Title * 67. How many years has it been since you completed excimer laser therapy? Please answer in whole numbers. Question Title * 68. Have any of the areas that repigmented from excimer laser therapy lost color again? Yes No Question Title * 69. What is your sex? Male Female Transgender Question Title * 70. What is your race? White/ Caucasian Black/ African American Asian Indian (from India) Native American Hispanic/ Latino Other (please specify) Question Title * 71. Is your vitiligo one one side of the body (unilateral) or both sides of the body (bilateral)? Unilateral Bilateral Other (please specify) Question Title * 72. What parts of your body are involved by the vitiligo? Scalp Eyelids Lips Forehead Ears Nose Cheeks Chin Neck Chest Stomach Back Upper arms Forearms Hands Wrists Fingers Genitalia Buttocks Thighs Calves/ Shins Ankles Feet Toes Other (please specify) Question Title * 73. What is the worst/ greatest percentage of your body ever involved with vitiligo (please remember that your palm represents 1% of your body surface area)? None 0-25% 26-50% 51-75% 76-99% 100% Other (please specify) Question Title * 74. Where were you born? City, State, Country Question Title * 75. Where do you live currently? City, State, Country Question Title * 76. What is your highest level of education? Grade school High school GED 2-year college 4-year college Graduate school Multiple graduate degrees Question Title * 77. What is your household income bracket? (Check one) <$25,000 per year $25,000-50,000 per year $50,001-75,000 per year $75,001-100,000 per year $100,001-150,000 per year $150,001-200,000 per year More than $200,000 per year Other (please specify) Question Title * 78. Have you ever had a skin cancer? Yes No Question Title * 79. If you answered Yes to #75, what kind of skin cancer did/do you have? Question Title * 80. Has anyone in your family had a skin cancer? Yes No Question Title * 81. If yes, who had the skin cancer and what kind? Question Title * 82. Before you complete this survey, do you have any other comments, questions, or concerns?Thank you for your participation! Done